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General NPI Number Information
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NPI Number | 1740412774
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Entity Type | Organization
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Legal Business Name | LARSON HEALTH PROVIDERS
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Dates
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Enumeration Date | 08/08/2009
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 419 N LARCHMONT BLVD STE 78
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone | 323-307-1552
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Fax |
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Provider Business Mailing Address
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Address Line | 419 N LARCHMONT BLVD STE 78
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City | LOS ANGELES
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State | CA
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Zip | 90004-3013
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JAMES M LARSON
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Credential |
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Telephone | 323-307-1552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | G38734
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License Number State | CA
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